Individual provider Active NPI

Robert James Anderson, MD

  • Family Medicine Physician
  • Green Bay, WI
National Provider Identifier
1477559938
Registry record updated Oct 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
37942 Issued in WI
Practice address
2502 S Ashland Ave
Green Bay, WI 54304-5252
Phone
(920) 496-4700
NPI assigned
Jun 21, 2005
Last updated
Oct 6, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 37942 WI Primary

Addresses

Primary practice location

2502 S Ashland Ave
Green Bay, WI 54304-5252

Mailing address

PO Box 19070
Green Bay, WI 54307-9070
Phone (920) 496-4700

Other practice location 1

831 Parker St
Algoma, WI 54201-0185
Phone (920) 487-3676

Other practice location 2

575 4th St
Kewaunee, WI 54216-1785
Phone (920) 388-4640

Other practice location 3

140B School Creek Trl
Luxemburg, WI 54217-1095
Phone (920) 845-1370

Other practice location 4

3415 Custer St
Manitowoc, WI 54220-4324
Phone (920) 652-9310

Other practice location 5

1630 Commanche Ave
Green Bay, WI 54313-5753
Phone (920) 433-6000

Other practice location 6

3263 Eaton Rd
Green Bay, WI 54311-6830
Phone (920) 433-6700

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address randerson27786@ewd.direct.hshs.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040311001325 WI Practitioner - Family Practice 4789573346 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical College of Wisconsin, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Clare Memorial Hospital, IncGroup PAC ID 0446211395, 62 clinicians

Practice addresses (Care Compare)

1411 N Taylor Dr
Sheboygan, WI 53081-3043
Phone (920) 457-4858

2502 S Ashland Ave
Green Bay, WI 54304-5252
Phone (920) 496-4700

3100 Superior Ave
Sheboygan, WI 53081-1948
Phone (920) 459-8300

835 S Main St
Oconto Falls, WI 54154-1282

950 Woodlake Rd
Kohler, WI 53044-1348
Phone (920) 783-3150

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.81 of 100Reported as apm
Quality
85.98
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
94.81 of 100Reported as apm
Quality
85.98
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
37942WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Oct 1, 2022 Accepting new patients
St. Nicholas Hospital-Sisters of the Third Order of St Francis Family Medicine Current Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Family Medicine CurrentSince Oct 1, 2022 Accepting new patients
Prevea Clinic, Inc. Family Medicine Current Accepting new patients
St Nicholas Hospital-Sisters of the Third Order of St Francis CurrentSince Oct 1, 2022 Accepting new patients
Prevea Clinic, Inc. Family Medicine CurrentSince Oct 1, 2022 Accepting new patients
St. Nicholas Hospital-Sisters of the Third Order of St Francis CurrentSince Oct 1, 2022 Accepting new patients
St Clare Memorial Hospital, Inc CurrentSince Jul 1, 2024 Accepting new patients

Locations

1510 Fremont St
Algoma, WI 54201
Phone (920) 487-3676

1726 Shawano Ave
Green Bay, WI 54303
Phone (920) 432-6016

2305 San Luis Pl
Green Bay, WI 54304
Phone (920) 494-2817

2502 S Ashland Ave
Green Bay, WI 54304
Phone (920) 496-4750

704 S Webster Ave
Green Bay, WI 54301
Phone (920) 433-3784

744 S Webster Ave
Green Bay, WI 54301
Phone (920) 433-6025

835 S Van Buren St
Green Bay, WI 54301
Phone (888) 901-7246

575 4th St
Kewaunee, WI 54216
Phone (920) 388-4640

855 S Main St
Ste 1
Oconto Falls, WI 54154
Phone (920) 846-8187

3100 Superior Ave
Sheboygan, WI 53081
Phone (800) 472-6710

Interoperability endpoints

  • Direct secure messaging: randerson27786@ewd.direct.hshs.org
  • Direct secure messaging: randerson32405@direct.thedacare.org

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665014400000",
    "number": "1477559938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19070",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543079070",
            "telephone_number": "920-496-4700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2502 S ASHLAND AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543045252",
            "telephone_number": "920-496-4700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "831 Parker St",
            "address_purpose": "LOCATION",
            "city": "Algoma",
            "state": "WI",
            "postal_code": "542010185",
            "country_code": "US",
            "telephone_number": "920-487-3676",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "575 4th St",
            "address_purpose": "LOCATION",
            "city": "Kewaunee",
            "state": "WI",
            "postal_code": "542161785",
            "country_code": "US",
            "telephone_number": "920-388-4640",
            "fax_number": "920-388-0479",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "140B School Creek Trl",
            "address_purpose": "LOCATION",
            "city": "Luxemburg",
            "state": "WI",
            "postal_code": "542171095",
            "country_code": "US",
            "telephone_number": "920-845-1370",
            "fax_number": "920-845-1379",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3415 Custer St",
            "address_purpose": "LOCATION",
            "city": "Manitowoc",
            "state": "WI",
            "postal_code": "542204324",
            "country_code": "US",
            "telephone_number": "920-652-9310",
            "fax_number": "920-652-9316",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1630 Commanche Ave",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543135753",
            "country_code": "US",
            "telephone_number": "920-433-6000",
            "fax_number": "920-430-4719",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3263 Eaton Rd",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543116830",
            "country_code": "US",
            "telephone_number": "920-433-6700",
            "fax_number": "920-433-6719",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "ROBERT",
        "middle_name": "JAMES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-21",
        "last_updated": "2022-10-06",
        "certification_date": "2022-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "37942",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "randerson27786@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "2502 S Ashland Ave",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543045252",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.